11 Sedative-Hypnotics & Insomnia

[Sedative-hypnotics] What three classes are in the study guide?

Benzodiazepines, benzodiazepine-like Z-drugs, and barbiturates.

[Benzodiazepines] Name common examples.

Lorazepam, alprazolam, and diazepam.

[Benzodiazepines] What is the mechanism?

Increase frequency of GABA-A receptor chloride-channel opening when GABA binds.

[Benzodiazepines] What are common clinical indications?

Anxiety, insomnia, seizures, muscle spasm, and alcohol withdrawal.

[Benzodiazepines] Common adverse effects?

Sedation, dizziness, impaired coordination, and memory problems.

[Benzodiazepines] Why must alcohol and opioids be avoided?

Additive CNS/respiratory depression; can cause overdose.

[Benzodiazepines] Why should chronic therapy not stop suddenly?

Withdrawal can cause rebound anxiety, tremor, and seizures.

[Flumazenil] What does it reverse?

Benzodiazepine sedative effects; monitor for seizures in dependent/mixed-overdose patients.

[Zolpidem] Class and indication?

Nonbenzodiazepine hypnotic (Z-drug) for insomnia.

[Zolpidem] What unusual safety issue must be taught?

Complex sleep behaviors such as sleepwalking or sleep-driving.

[Z-drugs] Name two others besides zolpidem.

Zaleplon and eszopiclone.

[Eszopiclone] What distinctive adverse effect occurs?

Unpleasant or bitter taste.

[Ramelteon] How does it differ from Z-drugs?

Melatonin receptor agonist for sleep-onset insomnia; not a controlled substance.

[Barbiturates] What is their mechanism?

Enhance GABA-A chloride-channel opening duration, causing CNS depression.

[Barbiturates] Why are they generally less preferred than benzodiazepines?

Higher toxicity, respiratory depression, enzyme interactions, dependence, and overdose risk.

[Phenobarbital] What is one common therapeutic use today?

Seizure control; monitor sedation and respiratory function.

[Barbiturate overdose] What is treatment priority?

Support airway, ventilation, circulation; no specific antidote.

[Insomnia] What should be tried before/with medication?

Sleep hygiene, regular schedule, and behavioral interventions.

[Insomnia] What antidepressants are mentioned as sedatives?

Trazodone and low-dose doxepin.

[Sedative-hypnotics] Why should ongoing benzodiazepines or barbiturates not be stopped suddenly?

Withdrawal may cause rebound symptoms or seizures; taper with prescriber guidance.

[Zolpidem/Z-drugs] What is the GABA-related mechanism?

Bind the benzodiazepine site on GABA-A receptors to enhance inhibitory GABA effects.

[Benzodiazepines] Which patients and combinations need extra caution?

Those with respiratory compromise; combining with opioids or alcohol can cause dangerous respiratory depression.